Although the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has already saved tax payers more than $12 million this year, it offers still more cost-saving recommendations for the Centers for Medicare & Medicaid Services (CMS) in its annual Red Book that hav....

For something that has been around for nearly 2 decades and supported by regulation since 1965, Advance Beneficiary Notices (ABNs) continue to cause headaches today. The use of written notices has been available since the enactment of PL 92-603 in 1972. The specific format called an Advance B....

In August 1996, the Health Insurance Portability and Accountability Act (HIPAA) [Public Law 104-191] established the infrastructure and funding for federal fraud and abuse efforts. This legislation authorizes the appropriation of $104 million in 1997, with increases in....

When we think of the False Claims Act (FCA) today, headlines of healthcare billing fraud and abuse settlements may come to mind. But the Act actually goes back to 1863, when the US government found itself ill-served by contractors who were selli....

Based on recent civil and criminal enforcement actions, third-party medical billing companies, healthcare consultants, and medical coding personnel (collectively referred to as "consultants" throughout this article) need to be aware of potential liabilities when providing se....

In the 1970s, the defense budget consumed the largest share of the federal budget. Concerns about both the size and efficiency of the defense bureaucracy triggered a massive crackdown on federal contractors who had either intentionally or inadvertently failed to follow the Department....

The possibility of an investigation related to fraud and abuse is the last thing most people want to think about, but it's important to be prepared, just in case. The author gives some advice on how to react if your facility is the target of an investigation and points out some imp....

According to the Department of Justice Health Care Fraud Report for Fiscal Year 1997, $1.2 billion was awarded or negotiated as a result of criminal fines, civil settlements, and judgments in healthcare fraud matters. And $517 million of that amount came from the settlements of three case....

From the U.S. Code Online via GPO Access [wais.access.gpo.gov] [Laws in effect as of January 2, 2001] [Document not affected by Public Laws enacted between January 2, 2001 and January 28, 2002] TITLE 31. MONEY AND FINANCE SUBTITLE III. FINANCIAL MANAGEMENT